Smoker with Ménière-like Episodes and a Corrigan Pulse

A 30-year-old male who had recently been treated for asthma exacerbation with steroid therapy presents to the vascular medicine clinic for follow up 4 weeks after visiting the emergency department (ED) with complaints of hearing issues with tinnitus, vertigo, and headaches. Over the preceding weeks, he began to develop nonspecific features of fever, fatigue, and mild weight loss. He noted slight improvement in tinnitus, vertigo, and headaches while on steroid therapy. He has been smoking one pack of cigarettes for 10 years and noted occasional skin changes when the weather is cold. He denied any proximal muscle pain or weakness. Pertinent physical exam findings include a blood pressure of 135/74 mmHg in the right arm and 133/70 mmHg in the left arm; a normal cardiac S1, S2 with a 1/6 diastolic decrescendo murmur best heard at the left sternal border with a Corrigan pulse. A soft bruit was appreciated in the mid-epigastrium. His pulse exam included the following: carotid and radial pulses were normal; the temporal arteries were non-tender; the lower extremities were normal. Pertinent laboratory evaluation in the ED was as follows: complete blood count was remarkable for low hemoglobin of 11.5 g/dL (normocytic anemia), a mild leukocytosis with a white blood count of 12.5 x 109/L, a normal platelet count of 329 x 109/L, and an elevated sedimentation rate of 87 mm/hr (normal <29 mm/hr) and C-reactive protein of 85 mg/L (normal <8 mg/L).

Based on the history, physical examination, and laboratory evaluation, what is the most likely diagnosis for this patient?

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